USA LIFE ONE.... Serving the Annuity & Life Insurance needs of the Senior Market Since 1894......Over 100 Years of Continuous Service!!!

                                         THIS PRODUCT HAS BEEN APPROVED IN THE STATE OF INDIANA, USA

Click on the PDF Button below that says - "APPLICATION", open the file and print it.

Now:

1. Complete the Application.

2. Sign and Date the Application where the "X" is indicated.

3. Return the completed Application to: USA LIFE 1, PO Box 609, Fishers IN, 46038

Once we approve the application, we'll send a letter confirming your acceptance into the plan and will then ask for the first month's premium. You do not need to send any money at this time and there is no obligation on your part for sending in the completed Application.

After you have paid your first months premium, we will send you a bill each month and you may simply pay by check.

                                       Call Toll Free at 1-800-970-1945 if you have any questions. 

This is a modified death benefit product which means, if death is due to an accident, we will pay the full face value of the policy regardless of when death occurs. If death is due to natural causes, such as cancer or a heart attack, during the first 36 months of your coverage, your beneficiary will receive all the premiums you paid plus 10 percent; you won’t risk a penny. After the first 36 months, 100 percent of the face value of the policy is paid regardless of how death occurs.